Happy Saturday, and welcome back to our weekly advice column, Ask D’Mine, hosted by veteran type 1, diabetes writer and instructor Wil Dubois.
Wil is speaking all of the effects it could have on people of with pancreases that are lazy and anxiety. Continue reading… you could just find a “cure” for what is stressing you out.
Note that this is the first of a column, as well, so make sure you check back!
Sharon, type 3 from Texas, writes:My grandson is 9 and is in his fourth year of T1D. Until recently he’s split his week along with his father and half with his mother and me (Grammy). His dad managing custody was given by A court case. He shifted my grandson’s school and living arrangements. My grandson resides with his father with vistation for my daughter and me on Thursday evenings and first weekends. In part because he was in my health insurance, also in part because no one stepped up, I was handling supplies and his physician visits throughout the pharmacy. I was often the one at the physician appointments.
I say this to establish that I was intensely involved and concerned for my grandson’s care and management of their diabetes. With the changes each time my grandson was with us he’s ended up with high BG readings at the 300s. I feel this stress from the fluctuations in his life. I’ve read several articles indicating that anxiety, stress, emotion, has the effect of elevating blood sugar. Fight or flight reaction. I haven’t seen any information to protect against these. This has become a major problem with interactions with his daddy. Any suggestions you have would be greatly appreciated.
Wil@Ask D’Mine answers: Yikes. Let me first say that I’m so sorry to hear about the household chaos surrounding you and your grandson. Poor kiddo. Were not enough as if diabetes. Seems like the courts should have contributed you , not his mother or his father your grandson. Or at least they should have granted custody of his diabetes as his parents were not “stepping up.”
Of course, that’s not how things operate. Plus it would not really be fair for you anyway, to possess not this boy’s enjoyable part, and just the diabetes.
Now, to your question. Yes, you’re 100% right that blood sugar could be elevated–even to quite substantial levels–by nervousness, anxiety, and feelings. And you’re also right that these elevations are linked to the flight or fight reaction. For those readers who may not have read on this, allow me to quickly review flight or fight until we talk about what to do about it, and if stress can really be treated with insulin.
Flight or fight is a evolutionary reaction to danger. To understand that, just jump in my literary time system. Back, back, back, back we go. On the dawn of history. Oh. Wait. That is not far enough. I think we might want to return to the twilight of history when our first ancestor climbed down from the trees, stood up on his back legs, and on teetering ft went off looking for a 7-11 Shop so that he could purchase a burrito. (I understand it was a man ancestor who did this, as the females were sensible enough to understand we were better off in the trees.)
Imagine this ape that is nude on the plains at the wilds of early Africa. He has no claws to defend himself , no sharp teeth. His hearing and vision are worse than most as animals go. His muscles are weak. He’s off to get a burrito, but I suspect he’s a lot more likely to end up as an afternoon snack to get a tiger, a guy, a bunch of hyenas, or even a snake.
In short, he’s at a disadvantage. But character came to his rescue by providing our ancestors super-human… uh… super pre-individual powers. At least for small intervals. When the lions, tigers, hyenas, and snakes come calling, the tiny glands atop our kidneys open up and fill us with adrenaline hormones that amp us up. Believe Australopithecines on crack. It is kind of sugar high. This gave them , and gives us energy to make tracks and run, or to stand our ground and fight. I suspect that at the twilight of history our ancestors did more running than fighting, but I could be wrong. But this adaption into a lack of fangs, claws, and muscle kept the breed alive and allowed us to evolve.
Back in the day, this sugar was quickly burned off flighting or fighting. But here is the problem. Now’s lions and tigers and hyenas and snakes are divorce court judges, fighting parents, new schools, and a scary, uncertain future. How do you, as a kid, battle with that? Or conduct out of that?
You don’t. And unlike a lion’s attack, modern stresses aren’t short-lived. They go on and on and on. But the body is stupid. It does not understand the distinction between a hungry lion and an ice estimate. Stress, to the entire body, is anxiety. And once we get anxious, our bodies dump sugar into our bloodstream. Because it is biological, we’re pretty much helpless to prevent it. The main remedies would be to fix or prevent the strain (good luck with that) or burn off the excess sugar by exercise. Like kick-boxing.
But what about a stress bolus? Can you inject your way from anxiety? The solution is: Yes. No. Maybe. Sometimes. Plus it depends.
That’s probably why you couldn’t locate any advice regarding how to do it.
OK. Here’s the deal. In the event that you were 100% stressed-out all of the time, you could just take more polyunsaturated fats and also be done with that. The dilemma is that anxiety is not really as uniform as it appears. It ebbs and flows. As do the stress hormones that drive up the blood sugar. Plus, while we’re not burning them off quickly as intended by flighting or fighting, we really do burn them off, albeit more gradually than Mother Nature thought.
To get a stressed-out, however motived adult (if such a individual exists–stress tends to decode resolve) frequent correction boli to “cure” the stress hormones would be the optimal solution. But for an anguished 9-year-old kid? Yeah. I’m not optimistic about that.
If the kid is so completely stressed-out that you will find not any normal blood sugar readings, raising the basal insulin is totally the very best solution. If the kid is on shots, then the best method to do this is to identify the child’s natural “low tide” point–the time during the day when his blood sugar is the lowest–and then increase the basal insulin a half-unit a day before the very low tide is hovering around the endo’s selected fasting goal (normally around 150 for small people). It is a bit more complicated, in case the kid is on a pump.
But where it gets trickier is when the background stress is variable and you’re seeing 100s and 300s. Or, God forbid, 300s and lows. It is not possible to fix highs without making the lows substantially worse using insulin if the number set is varied. In this case, the ideal solution is an ongoing Glucose Monitor (CGM) and a parent (or even a Grammy) with a great deal of time to provide. By simply taking a blizzard of small boluses you’ll want to combat each high. A dozen a day. You will also have to use a more aggressive correction factor to deal with stress highs since the endocrine driving the high is less responsive to insulin compared to “garden variety” blood sugar is.
So that you are. You may choose to stand and fight — as your weapon with insulin when assaulted by your nature.
Well, crap, I’ve run out of space and time (and java, damnit) today. But I have some thoughts about how you might be able to deal with the very final thing that you mentioned: The problem of diabetes and medical interactions in divided families. So tune in next week, same time, same station, and we’ll talk about that.
Tune in next week for the continuation on a related subject
Disclaimer: this isn’t a medical advice column. We are PWDs freely and openly sharing the wisdom of our accumulated experiences — our been-there-done-that knowledge from the trenches. But we’re not partridges in pear trees, or MDs, RNs, NPs, PAs, CDEs. Bottom line: we are a part of your prescription. You need therapy, the expert guidance, and care of a licensed medical professional.
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